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How do home care agencies use technology?

Fri, 02/05/2010 - 13:57 - Laurie Orlov

Home care (unlike nursing homes) represent a growth market. Home care agencies are showing solid revenue growth according to the National Private Duty Association (NPDA). Seventy-one percent report that revenue increased from 2008-2009, despite a poor economy and 83% indicate that they are hiring in 2010. Meanwhile, nursing home beds are disappearing. And whether it is the CLASS act component of the health care bill or a trend to be named later, policy will eventually align to enable those who have long-term care coverage to receive that care in their preferred location -- at home, not in a skilled nursing facilities. So we have the result that all profess to have wanted for years. As with all 'this is what we wanted' trends, the law of (un)intended consequences prevails.

Home care agencies use technologies as management tools. A recent preview of the Fazzi National State of the Home Care Industry offers up a few statistics that can be very useful for vendors and others examining this market. For example, 23% of home care agencies use telehealth systems, but nearly 40% of large agencies and 50% of small agencies have telehealth units that are not in use. 50% of agencies with revenues of $5 million or more use a smartphone, half of those are using a BlackBerry. More than 72% of agencies reported cost-cutting initiatives, with most focused on enhancing productivity in the field. Although Electronic Medical Records (EMRs) have penetrated 65% of all agencies, 88.1% still maintain some paper charts.

Contrast what consumers and families want with agency focus. The Home Care Technology Association published a survey of stakeholders in the home care industry. On the consumer side, the priorities "include:

Receiving high quality care

Keeping costs at an acceptable level

Having access to care

Receiving wellness and prevention education

Maintaining a high quality of life

Aging in Place

And for the agencies:

Providing high quality care to patients

Organizational efficiency and effectiveness

Growing the business, increasing market share

Attracting and keeping high quality workers

Attending to the cost of providing services

Regulatory compliance, e.g., licensure"

Overlap is good -- quality and cost control. It's great that consumers, AARP, and agencies are aligned on desire for quality of care and control of costs. And of course, related to quality of care, the importance of keeping high quality workers who could provide continuity of and commitment to providing care. And home care on the surface appears to cost less -- the NPDA fact sheet notes that "20 hours of companionship home care costs $1500/month or $18,000 annually."

Who is watching the watchers? Telehealth system usage (or non-usage) aside, when just considering home aides who are not involved in healthcare, the coverage of 20 hours of companionship care leaves 148 hours per week with no companionship. To what degree are home care agencies considering augmenting those 20 companionship hours with any form of activity monitoring? Do they know about, resell or recommend PERS devices or passive fall detection? Do home care agencies regularly utilize web or security cameras? I have looked, but find no evidence that they do.

Industry is booming, but the workers, not so much. One reason for the growth in hiring, agencies must replace departed workers. According to the Bureau of Labor Statistics, "Occupations with the most replacement openings are usually large, with high turnover stemming from low pay and status, poor benefits, low training requirements, and a high proportion of young and part-time workers." Count home care workers as fitting that profile -- at $8.92/hour for companionship workers, according to NPDA -- even while most reporting turnover rates of '50% or less'.

Improve the quality of life for care recipient and worker. The ability to obtain great care, have an acceptable quality of life that enables aging in place outside of a nursing home at a lower cost to family, care recipient, and society -- it's what all say they want. But this is tough to achieve and demands continuity of oversight and care, not to mention a ready supply of competent and screened workers. That means that gaps of time without 'companionship' care are filled with monitoring and communication with a care recipient. It means that gaps in management oversight are filled with monitoring and interaction checkpoints for companionship aides -- extending well beyond a voice response system. It means that aides and care recipients should use telephone and pre-configured computer systems and software to power up their interactions with others -- outside the home.

History is very instructive. If you watched the growth in regulatory oversight of nursing homes over the past 20 years, it appears that many of the regulations are the result of serious risk to residents -- bad management, lack of oversight, incidents of endangerment. Let's make sure that doesn't happen with the home care boom. As the home care industry landscape grows and matures, hopefully we will see home care agencies broadly and actively seeking to deploy technologies that shore up well-clarified standards of care and communication -- between management and staff, among staff peers, and between staff, family members and care recipients. Then we can say with confidence that 'aging in place' with the support of home care really works.

If "20 hours of companionship home care costs $1500/month" and home care workers get paid "$8.92 per hour", a lot of new home care companies will be starting up soon!

I believe that "aging in place" is an idea whose time has come. The age wave will drive trends towards universally designed more accessible and affordable homes, adoption of user-friendly AIPT and in-home telehealth connections between seniors, family caregicers and heathcare providers, and innovative new community and volunteer support systems for seniors and their caregivers.

Our emerging "healthcare economy" and out of control healtcare costs will require a bold new vision of aging in place along the lines of Joe Couglin's "Quality Aging" model.

There's room for optimism that someone with the required "imagination and will" to lead the way into the coming era of "aging in place" will emerge soon.

I'll add another way that we use technology -- to allow remote family cargivers to login to a private, secure family web portal to review the care and status of their loved one.

This is especially important when family are remote -- which an mean across town or across the country -- and need to review information to make good decisions. Rather than having to travel on-site to client's house to review the written records, they can see daily home care records to determine if additional attention is required, or ensure that plans of treatment are being followed. Other times, they simply want to ensure that agency caregivers have arrived as scheduled or to give specific instructions for a day's activity.

We can do this because our home care caregivers, not just supervisors, carry smart phones and provide real time updates as they deliver care throughout the day. Because of this, family members can see in great detail what has been happening regardless of where they are. This greatly simplifies the challenges of busy families who are trying to remotely manage the home care of a loved one.

Mr. Jenkins explains how the medminder Intelligent Pillbox System has significantly helped his clients in taking their medicines at the right time. The family members of the users are also very happy with the notifications they receive via email, cell phone, text message. Collecting all of the medicines and dosages into one system and tracking the taking of these meds over time is extremely helpful for the patient's family and the caregivers.

As a long-time NPDA member and yearly attendee at the Annual Meeting, I am always amazed (and pleasantly surprised) at the number of people who are just on the verge of starting or are actively involved in the business of home care. It's a close-knit and rewarding business to be in, but unfortunately (for owners), remains a very low-tech industry. Having been an owner of a private duty business and now a vendor to hundreds of agencies, I have seen the pitfalls of not integrating available technology into running a home care business. Since it's the beginning of 2011, I'd like to issue a challenge for agencies to embrace technology!

On the front lines is your website. Everyone has one, but is it efficient and are you using technology to your advantage? Do clients and potential clients call you to ask easily-answered questions that if put on your website can save you time? Does it include a place for customer comment cards or web-based survey forms? Consider integrating technology like Skype for one-click access to connecting with you. Are you using social networking to your best advantage? You can easily add a "share" button or badge on your sites for people to share your website on Facebook or Twitter. Technology on your website can allow you to reach more people without lifting a finger.

As a private pay home care agency owner, you know the value of organization. You also know the demands awaiting you every single day. In a 24-hour period, you can be pulled in any number of different directions. Your staff has needs. Your clients have needs. And then there are the administrative duties! If there were a way to use technology available to help you organize your day, save time, and increase productivity, wouldn't you want to take advantage of it? I cringe when I hear some owners are doing things by hand or with home-grown systems. There are many telephony platforms available that are affordable and geared for smaller operations. Here are my top 5 reasons to use telephony technology:

Improved service delivery. Caregivers show up on time and leave on time because they know they are being monitored.

You can be proactive instead of reactive when a caregiver is a no show (an unfortunate reality). It’s better to call and fix the problem rather than wait for the call from an irate family member.

Telephony is a great marketing tool. Referral sources love to hear that agencies have more control over their caregivers.

Billing disputes become rare. You can prove with 100% accuracy that a caregiver was where he or she was supposed to be.

If telephony is used correctly, billing and payroll become very streamlined in comparison to time sheets, saving time and money.

Any business is going to be more successful when you know how you are performing. Often overlooked, getting feedback from your clients doesn't have to be done the old-fashioned way. Integrate online surveys (i.e. www.surveymonkey.com) or get really into technology and consider services like that provided by www.homecarepulse.com. They offer statistics and reports that will allow you to benchmark and see how you are really doing with clients, instantly streamlining business decisions.

About the authorRick Morey has been in the home care industry since 1993. He owned and sold a large home care company in California and Arizona which had annual sales of $6,000,000. Soon thereafter he began HomeTrak, a scheduling & business management software platform for the private duty home care industry. Rick is a charter member of the National Private Duty Association and is currently on the NPDA board of directors. For more information about Rick, please visit www.HomeTrak.com or on Twitter @HomeTrak. Rick also moderates a Home Care Technology group on Facebook at http://tinyurl.com/2832547.